Treatment of Severe Sequelae of Infantile Hip Sepsis With Trochanteric Arthroplasty

Abstract

We retrospectively reviewed 30 hips in 30 patients with complete destruction of the femoral head and neck from infantile septic arthritis to investigate the result and the ideal age for performance of trochanteric arthroplasty. All patients were treated with a 1-stage trochanteric arthroplasty at age from 11 to 98 months. We measured the range of motion of the hip, and we used the modified Harris hip score to evaluate pain and hip function and the multiplier growth-remaining method to assess predicted limb-length discrepancy. At a mean 7-year follow-up, we found that the modified Harris hip scores were negatively correlative--and the predicted limb-length discrepancy positively correlative--with the age at surgery in months. Range of motion in flexion and abduction of the hips of patients operated on at age older than 4 years were worse than that of the hips of patients operated on at age younger than 4 years. Therefore, we recommend that trochanteric arthroplasty should be performed as early as age 1 year for children with Hunka type V deformities after infantile septic arthritis of hip. Children older than 4 years might be contraindicated for trochanteric arthroplasty.

The management of septic arthritis in children

“…The hip has the worst outcome of all joints, as elevated intracapsular pressure causes occlusion or thrombosis of retinacular and transphyseal vessels, and also because sepsis induces subluxation of the femoral head. 8,78,79…”

Failed vascularized proximal fibular epiphyseal transfer for hip reconstruction following infection in children

“…The main objectives of all these procedures are to restore articular stability, maintain the functional articular range of movement, eliminate pain, and reduce any inequality in limb length [6]. Trochanteroplasty is an old procedure that is often associated with other techniques, such as femoral varization and pelvic osteotomy [5, 18, 19]. It is indicated in children younger than 6 years.…”

Septic Hip Dislocation with a Preserved Femoral Head: Successful Outcome Following Open Reduction

“…At a mean of 15-year follow-up, they reported satisfactory outcome in 5 patients and recommended staged procedure to reduce the risk of avascular necrosis. Another study reviewed 30 hips with Hunka type V treated with trochanteric arthroplasty (Wang et al 2007). They recommended a single stage procedure as early as one year of age.…”

“…Delayed or missed diagnosis, especially in newborns is one of the major factors for poor outcome but the residual sequelae is quite diverse and unpredictable. Various procedures have been described to overcome residual deformities as a result of septic arthritis of the hip (Dobbs et al 2003;Choi et al 2005;Wang et al 2007), with varied results. Generally, age at presentation and types or severity of the condition determine the choice of management.…”